Maleki-Yazdi Keon Andre, Heen Anja Fog, Zhao Irene X, Guyatt Gordon H, Suzumura Erica A, Makhdami Nima, Chen Lina, Winders Tonya, Wheeler Kathryn E, Wang Julie, Spergel Jonathan, Silverberg Jonathan I, Ong Peck Y, O'Brien Monica, Martin Stephen A, Lio Peter A, Lind Mary Laura, LeBovidge Jennifer, Kim Elaine, Huynh Joey, Greenhawt Matthew, Frazier Winfred T, Ellison Kathy, Capozza Korey, De Benedetto Anna, Boguniewicz Mark, Begolka Wendy Smith, Asiniwasis Rachel Netahe, Schneider Lynda C, Chu Derek K
Department of Medicine, McMaster University, Hamilton, Canada.
Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway.
JAMA Dermatol. 2023 Mar 1;159(3):320-330. doi: 10.1001/jamadermatol.2022.6045.
Patient values and preferences can inform atopic dermatitis (AD) care. Systematic summaries of evidence addressing patient values and preferences have not previously been available.
To inform American Academy of Allergy, Asthma & Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force on Practice Parameters AD guideline development, patient and caregiver values and preferences in the management of AD were systematically synthesized.
Paired reviewers independently screened MEDLINE, Embase, PsycINFO, and CINAHL databases from inception until March 20, 2022, for studies of patients with AD or their caregivers, eliciting values and preferences about treatment, rated risk of bias, and extracted data. Thematic and inductive content analysis to qualitatively synthesize the findings was used. Patients, caregivers, and clinical experts provided triangulation. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research) informed rating of the quality of evidence.
A total of 7780 studies were identified, of which 62 proved eligible (n = 19 442; median age across studies [range], 15 years [3-44]; 59% female participants). High certainty evidence showed that patients and caregivers preferred to start with nonmedical treatments and to step up therapy with increasing AD severity. Moderate certainty evidence showed that adverse effects from treatment were a substantial concern. Low certainty evidence showed that patients and caregivers preferred odorless treatments that are not visible and have a minimal effect on daily life. Patients valued treatments capable of relieving itching and burning skin and preferred to apply topical corticosteroids sparingly. Patients valued a strong patient-clinician relationship. Some studies presented varied perspectives and 18 were at high risk for industry sponsorship bias.
In the first systematic review to address patient values and preferences in management of AD to our knowledge, 6 key themes that may inform optimal clinical care, practice guidelines, and future research have been identified.
患者的价值观和偏好可为特应性皮炎（AD）的治疗提供参考。此前尚无针对患者价值观和偏好的证据的系统总结。
为美国过敏、哮喘与免疫学会（AAAAI）/美国过敏、哮喘和免疫学会（ACAAI）关于实践参数的特应性皮炎指南制定联合工作组提供信息，系统综合了患者及护理人员在特应性皮炎管理中的价值观和偏好。
配对的评审人员独立筛选了MEDLINE、Embase、PsycINFO和CINAHL数据库，从数据库建立至2022年3月20日，查找有关特应性皮炎患者或其护理人员的研究，引出关于治疗的价值观和偏好，评估偏倚风险，并提取数据。采用主题和归纳性内容分析法对研究结果进行定性综合。患者、护理人员和临床专家提供了三角验证。GRADE-CERQual（推荐分级评估、制定和评价-定性研究综述证据的可信度）为证据质量评级提供了参考。
共识别出7780项研究，其中62项符合要求（n = 19442；各研究的中位年龄[范围]为15岁[3 - 44岁]；59%为女性参与者）。高确定性证据表明，患者和护理人员倾向于从非药物治疗开始，并随着特应性皮炎严重程度的增加而加强治疗。中等确定性证据表明，治疗的不良反应是一个重大问题。低确定性证据表明，患者和护理人员更喜欢无味、不可见且对日常生活影响最小的治疗方法。患者重视能够缓解皮肤瘙痒和灼痛的治疗方法，并倾向于谨慎使用外用糖皮质激素。患者重视牢固的医患关系。一些研究呈现了不同的观点，18项研究存在行业赞助偏倚的高风险。
据我们所知，在首次针对特应性皮炎管理中患者价值观和偏好的系统评价中，已确定了6个可能为优化临床护理、实践指南和未来研究提供参考的关键主题。
